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ABS20191101_0010
| Bifurcation/Left Main Diseases and Intervention | |
| Strut and Flow Analysis of DES Platforms in a Benchtop Bifurcation Model | |
| Jaryl Ng1, Shengjie Lu1, Han Wei Toh1, Hwa Liang Leo2, Philip Wong1, Liam Zhong1, Elvin Kedhi3, Wojciech Wojakowski4, Pawel Gasior4, Hui Ying Ang1 | |
| National Heart Centre Singapore, Singapore1, National University of Singapore, Singapore2, Isala Zwolle, Netherlands3, Medical University of Silesia, Poland4 | |
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Background:
Bifurcation lesions account for approximately 25% of all coronary intervention cases and are associated with high risk of stent thrombosis and restenosis. Currently, there are dedicated stent platforms developed specifically for bifurcation stenting, with high overexpansion capabilities or reduced floating struts disruption flow into the side branch (SB). However, the effect of the presence of struts in the side branch (SB) ostia on flow disturbance and thrombus formation has not been extensively tested.
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Methods:
Four stent platforms (n=4): BiOSS LIM C (Balton, Poland), Ultimaster Tensei (Terumo Corp., Japan), BioMime (Meril Life, India) and Xience Sierra (Abbott Laboratories, United States) were tested. The stents were deployed in a Y-shaped bifurcation silicone model (Proximal Diameter: 5.5mm, Main Branch: 3.5mm and Side Branch: 3.5mm), with proximal optimization technique and distal post dilatation being performed to ensure full apposition. The stent models were then perfused with porcine blood (with 10% ACD anticoagulant) for up to 60 minutes. OCT pullbacks of the perfused models were used to calculate % of floating struts and thrombus formation in the ostia. 2D computational fluid dynamic (CFD) models were created using the OCT pullback to predict the flow and determine regions with high thrombotic risk.
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Results:
OCT analysis showed that BiOSS had the lowest percentage of floating strut at the SB ostia compared to the other three stents (BiOSS: 0.7 ¡¾1.4%*, Ultimaster: 12.8 ¡¾ 2.4%, BioMime: 16.7 ¡¾ 2.4%, Xience: 13.5 ¡¾ 4.5%, p< 0.05). Thrombus formation based on OCT suggested a significantly higher thrombus area at the SB ostia in the BioMime and Xience groups (BioMime: 0.39 ¡¾ 0.04 mm2; Xience: 0.47 ¡¾ 0.03 mm2 vs. BiOSS: 0.03 ¡¾0.04 mm2; Ultimaster: 0.24 ¡¾ 0.03 mm2, p < 0.05) at 60 minutes. CFD analysis predicted a similar trend with Xience (0.17 mm2) and BioMime (0.2 mm2) have larger regions of high shear rate (>1000s-1) compared to BiOSS (0.07 mm2) and Ultimaster (0.09 mm2).
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Conclusion:
In summary, the presence of floating struts in the SB ostia caused flow disruption and generated larger regions of high shear rate. This could potentially result in the higher thrombus formation at the ostia.
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